THE WEEK IN HEALTHCARE;MATERNITY-STAY RULE SPARKS BACKLASH

The debate over limited maternity stays is triggering a backlash in Minnesota against specific, mandated insurance benefits.

Minnesota probably will become the next state to require insurance coverage of 48-hour maternity stays. As in many states, citizens and lawmakers there have expressed outrage over managed-care policies limiting new mothers' hospital stays to 24 hours. They fear that such care is inadequate.

But mandates are sparking growing protests from another faction in Minnesota: employers and health plans.

With their backing, state Sen. Sheila Kiscaden (R-Rochester) has proposed empowering an agency to analyze proposed benefit mandates and recommend policy. The Minnesota Health Care Commission, which advises the Legislature on healthcare reform, is one candidate. The bill hasn't been debated yet by the full state Senate.

"Minnesota is second in the nation in terms of the number of mandates we have already passed," said Michael Scandrett, executive director of the Minnesota Council of HMOs. "We believe that mandates may be appropriate in some cases, but the Legislature has not had good information on the issues. And as the mandates have accumulated, there's been real pressure for employers to move to self-insured plans to avoid them."

Last year, the Minnesota Legislature passed a law requiring health plans to cover bone marrow transplants for breast cancer patients. The treatment is very controversial. Doctors still debate its efficacy, and in several high-profile cases, women have sued their health plans for coverage.

All told, the state has issued 30 mandates regarding health benefits, Scandrett said. Only Maryland has been more active with 34 mandates, he said.

The HMO trade group hasn't opposed the 48-hour-stay bills, Scandrett said. It is concerned, however, that the Senate version would make patient preference the deciding factor, instead of medical necessity.

The Senate is expected to vote on the proposal shortly. The House bill already has passed.

"I don't think anything is going to stop this puppy," said Dave Feinwachs, general counsel of the Minnesota Hospital and Healthcare Partnership. "This is a dicey issue for us. We don't oppose the legislation, but we have historically opposed legislation that mandates the practice of medicine."

Massachusetts was the most recent state to enact legislation regarding maternity stays (Jan. 8, p. 20). It plans to outline the conditions under which mothers and their newborns can be discharged from hospitals less than 48 hours after delivery.

Maryland, New Jersey and North Carolina also have laws in place defining maternity coverage.

In Wisconsin, the state Assembly is considering a bill requiring health plans to cover home visits for mothers discharged before 48 hours.